Correspondence
Adult patients with parapneumonic empyema who may not require pleural drainage
Pacientes adultos con empiema paraneumónico que pueden no requerir drenaje pleural
J.M. Porcel
, H. Valencia, S. Bielsa
Autor para correspondencia
Pleural Medicine Unit, Department of Internal Medicine, Arnau de Villanova University Hospital, Lleida, Spain
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array:22 [ "pii" => "S0014256516000047" "issn" => "00142565" "doi" => "10.1016/j.rce.2016.01.001" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1232" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2016;216:172-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 65 "formatos" => array:2 [ "HTML" => 5 "PDF" => 60 ] ] "itemAnterior" => array:18 [ "pii" => "S0014256516000023" "issn" => "00142565" "doi" => "10.1016/j.rce.2015.12.005" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1230" "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2016;216:171-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 79 "formatos" => array:2 [ "HTML" => 3 "PDF" => 76 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondencia</span>" "titulo" => "Influencia de la información clínica en la interpretación electrocardiográfica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "172" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The influence of clinical information in electrocardiogram interpretation" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Martínez-Losas, J. Higueras, J.C. Gómez-Polo, V. Cañadas-Godoy" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Martínez-Losas" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Higueras" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Gómez-Polo" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Cañadas-Godoy" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256516000023?idApp=WRCEE" "url" => "/00142565/0000021600000003/v1_201604010057/S0014256516000023/v1_201604010057/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "Adult patients with parapneumonic empyema who may not require pleural drainage" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "172" "paginaFinal" => "174" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Porcel, H. Valencia, S. Bielsa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Porcel" "email" => array:1 [ 0 => "jporcelp@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "H." "apellidos" => "Valencia" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Bielsa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pleural Medicine Unit, Department of Internal Medicine, Arnau de Villanova University Hospital, Lleida, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pacientes adultos con empiema paraneumónico que pueden no requerir drenaje pleural" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The American College of Chest Physicians<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and the British Thoracic Society<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> strongly encourage prompt chest drainage when pus is obtained upon pleural aspiration. The underlying reason is that empyema is considered to be the last stage of a pleural infection and delays in initiating effective drainage may increase morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> However, no previous series have systematically examined whether antibiotics alone could result in complete resolution of empyema in individual cases and, if so, which predictors might support such a conservative approach. The aim of this study was to address this void.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We retrospectively reviewed the medical charts of all consecutive patients discharged from the Arnau de Villanova University Hospital (Lleida, Spain) with the diagnosis of thoracic empyema over the last 20 years. The local ethics committee approved the study protocol. Empyema was defined as the aspiration of macroscopic pus through a diagnostic thoracentesis procedure. Its parapneumonic origin was determined by the presence of associated lung infiltrates and/or the exclusion of other potential causes (e.g., surgical procedures, esophageal perforation, subdiaphragmatic infection, spontaneous bacterial empyema).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The following variables were collected: demographics, history of diabetes, white blood cell count at admission, size and laterality of pleural effusions and presence of loculated fluid on chest radiographs, pleural fluid and blood cultures, duration and type of antibiotic therapy, chest tube sizes and use of intrapleural fibrinolytic agents in patients who underwent pleural drainage, co-administration of nonsteroidal anti-inflammatory drugs, and infection-related mortality. The size of the effusion was assessed by standard posteroanterior radiographic views, whenever possible, and by visually estimating the area of the hemithorax occupied by pleural fluid.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Empyema patients were classified into those who underwent pleural drainage (i.e., therapeutic or iterative thoracentesis, chest tube, surgery) in addition to antibiotic therapy (group 1), and those who were solely treated with antibiotics (group 2); a decision made by the patient's attending physician. Therapeutic thoracentesis was defined as the maximum evacuation of fluid. Between-group comparisons for qualitative and quantitative variables were performed with the Fisher exact and Mann–Whitney <span class="elsevierStyleItalic">U</span> tests, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After excluding 38 patients for whom outcome data or medical history was incomplete or unavailable and 16 with a non-parapneumonic empyema (6 esophageal perforation, 5 abdominal surgery, 2 trauma, and 1 each pneumonectomy, pleurodesis and ventriculoperitoneal shunt), the study population comprised 129 empyema patients (77% men) with a median age of 56 (42–72) years, whose main characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were 110 patients in group 1 and 19 in group 2. Definitive pleural drainage modalities in the former were: therapeutic thoracenteses (2 cases, 1.8%); thoracic surgery, for which 4 cases was the initial treatment and 11 more followed chest tube drainage failure (15 cases, 13.6%); and tube thoracostomy (93 cases, 84.5%). Intercostal drain insertion was done using either small- (≤12<span class="elsevierStyleHsp" style=""></span>F, 58%) or large-bore (16–32<span class="elsevierStyleHsp" style=""></span>F, 42%) chest tubes. Intrapleural fibrinolytics were administered in 57% of the patients, urokinase being the preferred agent (90%). In 84% of patients, the chest tube was placed during the first 24<span class="elsevierStyleHsp" style=""></span>h of the diagnostic thoracentesis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Overall, 63% of empyema fluids were culture positive. The bacteria most commonly isolated were <span class="elsevierStyleItalic">Streptococcus viridans</span> (39%), <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> (23%), and Gram-negative aerobic organisms (20%), with an equal distribution between groups 1 and 2. Antibiotic selection was also similar for both groups, and mainly consisted of β-lactam/β-lactamase inhibitors (62%) and third-generation cephalosporins (17%).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Apart from the uncertain clinical relevance of a slight difference based on the effusion's laterality, the effusion's size itself was the most significantly different parameter between patients who were eventually subjected to chest drainage and those who were not (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Among the group 2 empyemas, 67% occupied less than 1/3 of the hemithorax as compared with 7% of group 1. Moreover, in three of four small drained empyemas for which enough information was available, the total amount of withdrawn pus was less than 150<span class="elsevierStyleHsp" style=""></span>mL. Pleural fluid loculations were not good indicators of which patients went on to receive antibiotics or pleural drainage. Of importance, infection-related mortality did not differ between the pleural drainage and antibiotics alone groups (11% vs 20%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.39).</p><p id="par0040" class="elsevierStylePara elsevierViewall">It was found that nearly 15% of adults with parapneumonic empyema were successfully treated only with antibiotics. All had small effusions (≤1/3 of the thorax filled on chest radiograph), which may have potentially hampered the placement of a chest catheter. Previous reports on pleural infection management did not make a distinction between non-purulent complicated parapneumonic effusions (i.e., positive pleural fluid cultures and/or pleural acidosis) and classic empyemas (grossly purulent pleural fluid).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4–7</span></a> A possible exception is a series of 119 patients with parapneumonic empyemas, defined as “opaque” pleural fluids, in which 5 (4.2%) were treated with antibiotics alone and three survived.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The main limitation of this study is its retrospective design with the resultant missing data. The exclusion of 38 cases because of incomplete data or lost to follow-up might have skewed the results. Also, decisions on whether or not to insert a chest tube were based on the subjective criteria of the attending physician, which raises concerns of a potential classification bias. Moreover, it is not completely surprising that some patients with small empyemas may not require drainage. In fact, many patients discharged with a drained empyema still have some residual collections that resolve conservatively. Finally, there was a non-significant trend towards worse outcomes in the non-drainage group (20% vs 11% infection-related mortality rate) that requires further exploration in an adequately powered study. Only a randomized controlled trial could answer the question of whether small volume empyemas can be cured solely with antibiotics. However, it is highly unlikely that this will take place since a treatment branch in which patients with purulent pleural fluids receive antibiotics exclusively is difficult to reconcile with current guideline recommendations.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, some patients with small volume parapneumonic empyemas can be effectively managed with antibiotics alone. Even so, they require a close clinical reevaluation during treatment as an increase in pleural fluid or failure of the patients's condition to improve in a short period of time warrants immediate pleural drainage.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Data are given as median (IQR) or no. (%) as appropriate. <span class="elsevierStyleItalic">Abbreviations</span>: NSAID, nonsteroidal anti-inflammatory drugs; PE, pleural effusion; WBC, white blood cell.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients group 1/group 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drained empyemas (group 1) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Undrained empyemas (group 2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age, years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">110/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (41–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (44–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male sex</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">110/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">History of diabetes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">108/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">WBC count, ×10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">9</span></span><span class="elsevierStyleItalic">/L</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100/13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.1 (9.8–19.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 (11.3–26.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chest X-ray, PE size</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99/18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><1/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (67)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥1/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (54)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chest-X ray, PE laterality</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">107/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (56)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (31.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (10.5)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chest X-ray, loculations</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94/7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pleural fluid cultures, positive</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">104/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Blood cultures, positive</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57/7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antibiotic therapy, days</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96/14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (21–42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (18–30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Concomitant use of NSAID</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">108/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Infection-related mortality</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">109/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024422.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Significantly higher than the respective values in other groups.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.L. 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